Cost of switching to ALS?

[AlmostJesus]

Hey guys/gals,

While I was in high school, I took an EMT-B course and worked for my local small-town ambulance service my senior year of high school. I am now in working on my bachelors in nursing and while I was doing that, I took a paramedic course. Unfortunately, it is difficult to find a job in the city I go to school at because I can only work part-time and I am straight out of school in a paramedic saturated area. Thus, I am working with some of the outlying areas to find a job working in an ALS service. The service I worked for in HS was BLS except they used nurses for transfers. Now that I am a paramedic and a couple others that work there are pursuing their paramedic, I am going to talk to the director about upgrading to ALS with eventually a paramedic on call 24/7. I have been working on protocols and other business issues. The one issue where I am falling short is finding out the cost of outfitting some ALS bags. Currently, for nurse transfers, the hospital keeps a drug box that they sign out to the ambulance and then bills for the medications they use. I was thinking we could do a similar situation, but put the meds in an ALS type bag and check out the bag to the paramedic on call.

I was wondering if you guys could come up with a rough estimate that it would cost for a decent ALS bag set up for medications, O2, King tubes (no intubation), IVs, and any other equipment required of an ALS provider. I can draw the minor supplies from our stock, but I am mostly looking into the costs for the major equipment upgrades.

Also, if you guys have anything I could use as justification for upgrading to an ALS system, I would be open to hearing it (My boss is money minded, so things of that nature are better)

Thanks

Michael

[Chief1C]

Well, if you consider that a fully stocked BLS ambulance, sans cost of said ambulance, is about $35,000.00... b/c you can't just equip the ambo, you need extra stuff. Add about $30K to that if you're just being cheap about it. Then you have added insurance costs. You'll need quite a bit of some items that you use frequently. You can't just buy singles of some items, like angiocaths, they come by the case. So, you can see how these costs add up.

As for the cost of just a bag, with meds, supplies, etc., not including a reliable cardiac monitor, you're probably looking at close to $2,500.

Edited March 6, 2011 by 4c6

[Dedicated EMT 88]

Best thing to do is go to websites like allmed.com and buyemp.com They sell evrything you need for a als bag and ambulance. I used them to stock my POV bag. It only costed me about $100 to make a bls level bag, and about 450 of the $100 for for the bag itself. The other $50 was for supplies. Also check with your state and county to see what is required to be carried on the ambulance and in the bag. Each state and county have curtain thing that must be carried. But talk to your EMS director first to see if he would allow you all to go ALS. Then go from there.

[mobey]

I was wondering if you guys could come up with a rough estimate that it would cost for a decent ALS bag set up for medications, O2, King tubes (no intubation), IVs, and any other equipment required of an ALS provider. I can draw the minor supplies from our stock, but I am mostly looking into the costs for the major equipment upgrades.

I am pretty confused as to your motivation here.

Yes, I JUST did exactly what your asking.

I made a list of equipment, and submitted it to multiple distributors, recieved quotes, and built a buisness model to upgrade this service.

That is what YOU need to do to instigate change. That is what professionals do!

To be direct: Don't be so lazy, do your own homework.

BTW: $30k is Waaaaaaaaay off.

[Chief1C]

BTW: $30k is Waaaaaaaaay off.

Add about $30K to that if you're just being cheap about it.

Read the whole sentence, not just the first few words.

You could pick the cheapest, refurbed, back of a truck supply companies and get exactly what you pay for, if you want to. But don't expect to be very effective. In order to keep an adequate stock to stay in service, store it legally, etc.. It's going to probably require in excess of $150K to start.

Edited March 6, 2011 by 4c6

[mobey]

Read the whole sentence, not just the first few words.

Sorry 4c, I should have been more specific.

I am assuming, since the OP said "upgrading", this means that there are bls rigs stocked & available to be upgraded.

If you need to purchase a monitor with 12 lead capability, you would definatly be in the $30k range, however, if you have a monitor available or would be open to buying used, you can easily upgrade a truck for under $10k.

[crotchitymedic1986]

As others have stated, you can shop online and create your wish list with prices. To answer what has not been answered: If you are actually running calls that require ALS assessment/interventions, you can bill a higher rate. But in most areas you can not bill the ALS rate just because you have a medic onboard. So you will need to research your statistics and see how often you have ALS calls and do a cost benefit analysis based on those facts.

[AlmostJesus]

I have been working on putting together a list, Ill post it when I feel like I have everything, then you can tell me what I am missing.

To clarify, we already have 4 BLS rigs which at the minimum have a Datascope Passport and a defibrillator. We recently got two Lifepak 12's with NIBP, ETCO2, 12 Lead, SpO2, Biphasic via the Helmsley foundation and the AHA Mission Lifeline grant for SD. Thus, I think we have that area covered.

Currently, for ALS level transfers we use hospital nurses. Thus, the ambulance has some basic ALS equipment, but not set up for ALS calls. We have an agreement with the hospital which they provide us the medication boxes and bill us for what we use. I would like to change those into medication bags that the medic checks out at the beginning of the shift and then returns at the end for charging. We are also able to draw our disposable supplies from the hospital purchasing department, thus we would not need to order bulk for items which the hospital already stocks. (IE King tubes, BVMs, Defib pads, etc)

I am mostly interested in what I need to have equipment wise for this to work, in case I am missing something.

The reason why this is prompted is the hospital has been calling an ALS/Paramedic ambulance 50 miles away for transfers, undermining the previous agreements. Thus, he is losing many transfers which are the cash cow, add on ALS ambulance calls and the cost benefit should beat the initial costs plus the hourly cost of the paramedic.

Thanks for the help, hope that clears things up,

Michael

[island emt]

I have been working on putting together a list, Ill post it when I feel like I have everything, then you can tell me what I am missing.

To clarify, we already have 4 BLS rigs which at the minimum have a Datascope Passport and a defibrillator. We recently got two Lifepak 12's with NIBP, ETCO2, 12 Lead, SpO2, Biphasic via the Helmsley foundation and the AHA Mission Lifeline grant for SD. Thus, I think we have that area covered.

Currently, for ALS level transfers we use hospital nurses. Thus, the ambulance has some basic ALS equipment, but not set up for ALS calls. We have an agreement with the hospital which they provide us the medication boxes and bill us for what we use. I would like to change those into medication bags that the medic checks out at the beginning of the shift and then returns at the end for charging. We are also able to draw our disposable supplies from the hospital purchasing department, thus we would not need to order bulk for items which the hospital already stocks. (IE King tubes, BVMs, Defib pads, etc)

I am mostly interested in what I need to have equipment wise for this to work, in case I am missing something.

The reason why this is prompted is the hospital has been calling an ALS/Paramedic ambulance 50 miles away for transfers, undermining the previous agreements. Thus, he is losing many transfers which are the cash cow, add on ALS ambulance calls and the cost benefit should beat the initial costs plus the hourly cost of the paramedic.

Thanks for the help, hope that clears things up,

Michael

A lot of the equipment and supplies will depend on what your state requires you to have on board an ALS level truck.

Cric kit, chest decompression kits, does your protocol require RSI meds and training,? Probably not as your talking about using a basic airway such as the King LTD. CPAP or vents, portable infusion pumps are other things you might need to purchase.

It will depend on your local protocol's as to how much you need to spend.

[AlmostJesus]

A lot of the equipment and supplies will depend on what your state requires you to have on board an ALS level truck.

Cric kit, chest decompression kits, does your protocol require RSI meds and training,? Probably not as your talking about using a basic airway such as the King LTD. CPAP or vents, portable infusion pumps are other things you might need to purchase.

It will depend on your local protocol's as to how much you need to spend.

Thanks for the input

I am unable to find much information about the required equipment from our state, I had a list of required equipment, but it is universal to ambulance and I misplaced it and can't get it from the state website. The state I am in (SD) currently has a lazy state EMS director which is just counting his days until he retires. This makes things harder for getting information from the state regarding setting up an ALS level service. I am mostly going off of what equipment they had when I worked at one of the bigger services in the state for my internship.

As far as equipment suggestions

Cric Kit- I wasn't planning on having this due to the complexity of the procedure and lack of experience, my proposed protocols don't include RSI

Chest Decompression - I am including 2 NRP decompression needles

Like I said, No RSI, in the future I could look at doing RSA, but I don't think the medical director would be up to it, especially considering how few we would do and the lack of a 2nd medic

For airways, I was going to go with Kings LTS-D's initially, this should help with footing with the medical director and will have a lower initial cost with not that many disadvantages. This is especially important with the ease of putting in a king working in a single medic system.

I was looking at this for CPAP: http://www.buyemp.co...t/11230839.html

We wouldn't use it a ton, but I want it available

The hospital has a LTV1000 that if we had to transport a patient, we have an RT that works with the ambulance and would probably use the hospitals vent to transfer

The ambulance already has infusion pumps because of the nurse level transfers it does, they are compatable with the hospital sets but unfortunately are plumsets which are tough to run free-line, thus we would use the pump a lot for infusions in the field.

Ill try to get my full list up later tonite

On the other front, I was notified today that one of the other places I applied to is interested in hiring me pending farther up approval, this will give me an additional spot to practice to keep my skills up.

Edited March 8, 2011 by AlmostJesus